Breast cancer is the most common cancer and the second leading cause of cancer related death in American women. Regular screening, early diagnosis, and timely treatment initiation have been shown to reduce breast cancer morbidity and mortality. However, disparities continue to exist across the breast cancer continuum for underserved women, particularly minority women. The reduction of disparities in breast cancer outcomes is a major goal of Healthy People 2020 and the National Cancer Institute. However, the preventable burden of late stage breast cancer will continue until we close the gap between what is known about prevention and what is implemented in the community. Although many sources of information exist about theory and [theory-] and evidence-based interventions (EBIs) to promote mammography screening, their adoption and use in the community has been limited and haphazard at best. In order to effectively reach underserved women and reduce breast cancer disparities, D&I efforts should target the healthcare delivery system where these women receive service - the so called """"""""safety net"""""""". Within the safety net, federally qualified health centers (FQHCs), provide comprehensive primary health care services for underserved communities regardless of ability to pay, including mammography screening. Our team has successfully pilot tested a National Cancer Institute research tested intervention program (RTIP) with underserved women and were able to reduce no-show rates from 41% to 17%. In order to accelerate the adoption and implementation of our EBI within the safety net, we will use a two-step approach based on the consolidated framework for implementation research (CFIR), and intervention mapping. We will actively disseminate the EBI through a unique breast health collaborative with a wide membership of FQHCs, support implementation through training and evaluate the adoption, implementation, sustainment and effectiveness of the EBI. We will use a clinic randomized stepped wedge design for implementation. The program will be implemented in two waves of 10 FQHCs each with a target of reaching 466 women in each wave (n=932). We expect that our evidence-based approach to dissemination and implementation will lead to higher adoption, implementation and sustainment of the program, while maintaining high levels of EBI effectiveness within each clinic.

Public Health Relevance

Breast cancer is the most common cancer and the second leading cause of cancer related death in American women. Regular screening, early diagnosis, and timely treatment initiation have been shown to reduce breast cancer morbidity and mortality. However, disparities continue to exist across the breast cancer continuum for underserved women, particularly minority women. The reduction of disparities in breast cancer outcomes is a major goal of Healthy People 2020 and the National Cancer Institute. In order to reduce these disparities, we will actively disseminate an evidence based intervention (EBI) to improve mammography appointment attendance through a unique breast health collaborative with a wide membership of federally qualified health centers (FQHCs). We will support implementation through training and the removal of structural barriers and evaluate the adoption, implementation, sustainment and effectiveness of the EBI.